Robotics in the operative field

Use of Robotics in the operative field... Coding/billing options

As you may know the use of the operative robotic assist in the OR is really booming at this time... Right now, Urologists are using robotics for prostatectomies, OB/Gyns are using them for hysterectomies and other abdominal surgery, and Orthopedics is using them for Total Hips/Knee replacements....

As a coder, there are not any CPT codes that currently encompass use of a robotic device in surgery. So that leaves few options for billing the procedures.

First of all, before your physician performs the surgery, phone the insurance carrier to see if they will pay for a procedure that utilizes a robotic device. Some carriers regard this as "experimental" and will not pre-authorize or pay based upon that.

If you are lucky and the carrier does allow robotics.. your options for billing cpt codes are limited to only 2 options...

Option A: code the surgery with the CPT code that most closely resembles the surgery without the use of the robotic device, and add modifier 22 to show that your physician performed the procedure but with increased services


Option B: code the surgery as an "unlisted" code and note in the remarks line that this surgery most closely resembles code XXXXX but was performed with the assist of robotics.

With either option, be sure to send the carrier a copy of the operative note, and price your surgery competitively with your other surgeries.

Follow up with your carriers to ensure that they have recieved your claim, and will process in a timely manner.

Last but not least... keep your patient informed, and you may want to insist that your patient sign an advanced information document similar to an ABN, and collect for the surgery cost up front, or have a payment plan with the patient put on file.

However, I do recommend that you always perform your "due diligence" with any surgical procedure that is scheduled in advance:

** pre-authorize with the insurance carriers ANY surgery, (or surgical procedure)

** inform your patient up-front of the pre-auth findings

** Have an ABN signed (or ABN type document) by the patient clearly outlining what the cost for the surgical procedure is, and how much they (as the patient) could potentially be responsible for.

** Have a billing consent, a surgical consent, and a HIPPA & Privacy statement signed by your patient and on-file in your chart.

** Schedule the surgery!!!

Happy Coding & Billing....

Luvs.... L : )